{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:47:02Z","timestamp":1787755622998,"version":"build-2784847793"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10,18]]},"abstract":"\n Background:<\/jats:title>\n Pediatric femoral shaft nonunion after use of a plate or intramedullary nail (IMN) is uncommon in the United States. In low and middle-income countries, as defined by The World Bank, these complications may occur with greater frequency. We assessed the rates of union and painless weight-bearing after IMN fixation of pediatric femoral shaft nonunion in lower-resource settings.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We queried the SIGN (Surgical Implant Generation Network) Fracture Care International online database to identify all pediatric femoral shaft nonunions that had occurred since 2003 and had \u22653 months of follow-up after their treatment; our query identified 85 fractures in 83 patients. We defined nonunion as failure of initial instrumentation >90 days following its placement, lack of radiographic progression on radiographs made >3 months apart, or the absence of signs of radiographic healing >6 months after initial instrumentation. We evaluated the most recent follow-up radiograph to determine a Radiographic Union Scale in Tibial fractures (RUST) score. We also recorded rates of painless full weight-bearing as assessed by the treating surgeon.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Fifty-seven patients with pediatric femoral shaft nonunions (including 42 male and 15 female patients from 18 countries) were included. The average age (and standard deviation) at the time of revision surgery was 13.8 \u00b1 3.0 years (range, 6 to 17 years). The median duration of follow-up was 67 weeks (range, 13 weeks to 7.7 years). The initial instrumentation that went on to implant failure included plate constructs (56%), non-SIGN IMNs (40%), and SIGN IMNs (4%). At the time of the latest follow-up, 52 patients (91%) had a RUST score of \u226510 and 51 (89%) had painless full weight-bearing. No patient had radiographic evidence of femoral head osteonecrosis at the time of complete fracture-healing or the latest follow-up.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Pediatric femoral shaft nonunion can occur after both plate and IMN fixation in low and middle-income countries. IMN fixation is an effective and safe treatment for these injuries.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level IV<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.23.00315","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T14:34:53Z","timestamp":1690468493000},"page":"1594-1600","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Intramedullary Fixation for Pediatric Femoral Nonunion in Low- and Middle-Income Countries"],"prefix":"10.2106","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6865-9173","authenticated-orcid":false,"given":"Ryan J.","family":"Furdock","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6478-4965","authenticated-orcid":false,"given":"Lauren F.","family":"Huang","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1298-4751","authenticated-orcid":false,"given":"George","family":"Ochenjele","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8209-0809","authenticated-orcid":false,"given":"Lewis G.","family":"Zirkle","sequence":"additional","affiliation":[{"name":"SIGN Fracture Care International, Richland, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3041-8312","authenticated-orcid":false,"given":"Raymond W.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio"},{"name":"Division of Pediatric Orthopaedics, Rainbow Babies and Children\u2019s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"issue":"5","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"347","DOI":"10.5435\/00124635-200409000-00009","article-title":"Management of pediatric femoral shaft fractures","volume":"12","author":"Flynn","year":"2004","journal-title":"J Am Acad Orthop Surg."},{"issue":"4","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"207","DOI":"10.5435\/00124635-199507000-00003","article-title":"Femoral-Shaft Fractures in Children and 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